Policy Analysis
Why and How Should We Assess LCA has traditionally had a strictly environmental focus
Occupational Health Impacts in
Integrated Product Policy?
P A T R I C K H O F S T E T T E R * ,†,§ A N D
G R E G O R Y A . N O R R I S ‡,§
U.S. EPA, National Risk Management Research Laboratory,
26 West Martin Luther King Drive, Cincinnati, Ohio 45268,
and Sylvatica, 147 Bauneg Hill Road,
North Berwick, Maine 03906
See https://pubs.acs.org/sharingguidelines for options on how to legitimately share published articles.
Integrated product policy (IPP) and life cycle assessment
(LCA), one of the analytic tools used in IPP, focus
traditionally on environmental impacts. However, in an
Downloaded via 196.111.66.243 on February 21, 2022 at 06:39:41 (UTC).
attempt to consider other sustainability criteria and to avoid
a shift from environmental health impacts to occupational
health impacts one may want to include occupational
health in IPP. Should and can occupational health impacts
be included in LCA and IPP? Using published and
unpublished occupational health data for injuries and
illnesses and an economic input-output model of the United
States, we provide attributional occupational health
impacts measured in disability adjusted life years per
dollars output for 491 industry sectors including supply
chain impacts. Estimates for the “true” number of United
States occupational health impacts suggest that this initial
analysis underestimates the total impact 3-7-fold. A
comparison suggests that United States occupational health
impacts are about 10 times smaller than environmental
health impacts and are, relatively speaking, important only
for sectors with hazardous working environments but
low environmental impacts. A consequential rather than
attributional view suggests that a method to assess true
consequences on long-term health impacts by product policies
needs to be able to predict effects from present-day
work place exposure and to account for likely changes in
the labor market, including changes in unemployment
rates and other substitution mechanisms.
1. Introduction
Integrated product policy (IPP) has emerged as an area of
intense research and debate among policy makers in order
to better consider the “world behind the product” (1) and to
deal with the many dimensions of sustainable development
(2-4). New developments and interest in product life cycle
assessment (LCA) (5, 6) have been instrumental for these
developments, and LCA is one of the candidates to support
IPP in the future.
* Corresponding author phone: +41 43 288 5363; e-mail:
patrick_hofstetter@yahoo.com. Corresponding author address:
Oerlikonerstrasse 45, CH-8057 Zürich, Switzerland.
† ORISE Research Fellow at U.S. EPA, National Risk Management
Research Laboratory.
‡ Sylvatica.
§ Visiting Scientist at Harvard School of Public Health, Boston.
10.1021/es025838w CCC: $25.00  2003 American Chemical Society
Published on Web 03/25/2003
(5); only more recently, this role was reexamined (e.g., ref 7).
IPP and comparative analysis of alternative products may
need to provide much broader analyses including economic,
social, and environmental consequences of policies (e.g., refs
8-11).
Whether and how occupational health impacts should be
included in LCA has been debated among experts in the field
(12). De facto, LCAs carried out in Northern European
countries sometimes include an assessment of occupational
health impacts, others do not. Reasons to include occupa-
tional health impacts are as follows: (i) the responsibility for
environmental and occupational health impacts within
companies is often found within the same group or person;
(ii) environmentally motivated changes in production, design,
or consumer decisions should not be countervailed by shifts
to higher occupational health impacts and vice versa; and
(iii) addressing occupational health impacts in addition to
environmental impacts motivates workers to help in reducing
both (13-15). Getzner (15) suggests that companies active
in cleaner production often improve at the same time the
work environment. However, this has not yet been shown
on a life cycle basis.
In comparative risk analysis of energy systems oc-
cupational health impacts have been routinely included (e.g.,
refs 16-18). An integration of occupational and environ-
mental health into integrated management systems has been
advocated (19).
Reasons not to include occupational health are as
follows: (i) LCA should assess only environmental mediated
effects because other effects are often already internalized;
(ii) the burden of data collection and analysis is already (too)
high for environmental data alone; and (iii) LCA practitioners
lack the expertise in occupational health. Regarding reason
(i) we may need to consider that workers are in principle
compensated for occupational health risks by wage premi-
ums. However, Viscusi and Zeckhauser (20) acknowledge a
number of factors that would lead to an undercompensation
of occupational risks. These include the difficulty for workers
(but also for employers) to estimate the real risks they accept,
the fact that some of the health costs due to occupational
risks are carried by a greater insurance pool and support for
worker’s dependents may come from other general funds.
Finally, society may care more for worker’s health than the
workers do themselves.
If a method would reduce the burden of data collection
and reduce the need for expertise among practitioners, the
two practical reasons (ii and iii) against considering oc-
cupational health in integrated product policy would be
obsolete. The argument of not considering partly internalized
effects is important when the goal is to quantify external
effects only. However, if the goal is, e.g., to minimize health
effects due to products or services the argument does not
hold. Therefore, we conclude that if integrated product policy
is not just a means to quantify external effects but to minimize
total effects, and if we can provide methods that take care
of the feasibility aspects, there are good reasons to include
occupational health impacts in order to avoid shifting of
effects and suboptimization. This qualification makes clear
that inclusion or exclusion of occupational health will finally
depend on the goal and scope definition of a study.
The available methods for assessing occupational health
impacts in either product comparisons (LCAs) or system
comparisons differ in three main respects.
VOL. 37, NO. 10, 2003 / ENVIRONMENTAL SCIENCE & TECHNOLOGY 9 2025
 1. The Types of Occupational Health Impacts Included
and the Way They Are Presented. Most methods use data
on accident and illness cases that have to be reported by
companies to the government. Some methods focus on
fatality and morbidity cases only and some include number
of work-days lost (e.g., refs 16-18, 20-24). Others provide
disaggregated data that characterize the type of accident or
illness (e.g., refs 25 and 26). Some focus on potential toxic
effects only (e.g., ref 27) and others include in addition
psychosocial parameters such as work atmosphere, work task
content, and freedom to act (e.g., refs 28 and 29).
2. The Source and Aggregation Level for the Impact Data.
Methods that rely on information collected by governments
often use very aggregated data, i.e., combine a large variety
of different industry activities into the same sector (also called
branch method). Viscusi and Zeckhauser (20) use 38 sectors
for morbidity and 8 sectors for mortality data in the United
States. Schmidt et al. (26) use 80 sectors for Denmark and
CMU (24) about 500 sectors for the United States. Other
methods rely on company data that is often split between
different processes within the company that are relevant in
an LCA study (e.g., refs 25, 27, and 28) (also called process
method).
3. The Way to Account for Impacts in the Supply Chain.
Process chain analysis, input-output analysis, and hybrids
of these two methods characterize the chosen approaches.
The supply chain can be described with physical relationships
including all major contributing processes. Once occupa-
tional health data are collected for all these processes, iterative
computations or matrix algebra can be used to calculate
supply chain impacts (e.g., refs 25-28). Other methods use
the information of economic input-output models to
account for intersector relationships, which compels the
modeler to stick with the sectors provided in economic
input-output models (21-24). And some use a combination
of these two approaches to get, for immediate processes, a
good representation using a process model and, for the more
distant supply chain, a comprehensive assessment using
economic input-output information (e.g., ref 18).
The approach that is used in this paper includes infor-
mation on occupational injuries and illnesses provided by
companies to the U.S. Bureau of Labor Statistics. The illness
data does not include psychosocial impacts. The data
representative for 1999 is presented in a common health
metric that combines mortality and morbidity outcomes and
that is also used to assess environmental health impacts.
Since we use a 491 sector input-output model of the 1997
United States economy, the health impact data are also
aggregated to these 491 sectors. At the time of computation
(summer 2001) this is the most up-to-date, comprehensive,
and reproducible sector model for occupational health we
are aware of.
We attempt to answer the following questions with this
model: (1) How can information that is available on
occupational health be used for LCA/product policy? (2) Do
the occupational health rates vary enough among sectors to
justify this as a discriminating input into decision making?
(3) How complete is the available information? (4) Do
occupational injuries and illnesses matter when compared
to the health impacts arising from companies’ pollutant
releases?
All approaches mentioned so far attempt to attribute
occupational health impacts to the products or services under
study. Using these data to support product policy assumes
that if the number and types of produced products or services
change this would have a proportional effect on occupational
health impacts. To discuss this assumption we ask the
following questions: (1) How likely is it that an increase in
demand in a certain sector actually leads to a proportional
increase in occupational injuries and illnesses? (2) If a design,
2026 9 ENVIRONMENTAL SCIENCE & TECHNOLOGY / VOL. 37, NO. 10, 2003
purchase, or policy decision changes the working hours/
employment rate, how should we consider this in our
analysis? Is it relevant what we assume? Finally, we try to
answer the question in the title: (3) Should we consider
occupational health impacts in integrated product policy,
and if so, how?
Therefore, this paper introduces a method to assess
occupational health impacts, applies the method for the
United States, and uses the results to answer some of the
above questions.
Section 2.1 and Supporting Information S1 explain in
detail how the attributional model for occupational health
impact was built and calculated, Section 2.2 provides an
example of how to apply the results of the model, and Section
3.1 shows how incompletely occupational health impacts
are covered by this model. In Section 3.2 the results for
occupational health impacts are compared with those for
environmental health impacts, and in Section 3.3 we give
answers to the question whether, e.g., one fatality case due
to occupational health impacts can be added up or compared
with environmental health or other health impacts. Section
4 elaborates on the challenge of identifying the consequences
of changes in demand on occupational health. Finally, Section
5 revisits our questions above and concludes that available
methods and United States data are insufficient to include
occupational health impacts in today’s product decisions.
2. Attributional Occupational Health Impacts per
Industry Sector Output
Occupational health impacts within each United States
industry sector (direct) and the attributional impacts when
all supplying sectors are considered (direct plus upstream)
are quantified, and the application of these results is
demonstrated in a case study.
Occupational injuries and illnesses can be reported
following many different criteria including cause, nature, or
consequences. Here we are interested in the consequences.
Many metrics have been developed to measure and compare
health impacts. Number of cases, years of life lost, quality-
adjusted life years, or economic losses are just a few possible
options for measurement (30). Disability-adjusted life years
(DALYs) have been developed and introduced by the World-
bank and the World Health Organization (31). DALYs are
also used in Eco-Indicator’99 (32), an impact assessment
method to estimate damages from environmental stressors
within the framework of life cycle assessment. DALYs
combine cases of mortality and morbidity by considering
duration, severity, and number of cases i and j (eq 1). For
fatality cases the standard expected years of life lost (SEYLL)
at the age of death is taken from ref 31. Disability severities
are based on weights derived from expert panels and are
available for a large number of disabilities in ref 31. It is
measured on a scale from zero (perfect health) to one (death).
Options of discounting health impacts occurring in future
years and of additional age-weighting were not used in this
application.
DALYs ) Years of Life Lost (YLL) +
Years Lived Disabled (YLD) )
ΣiStandard expected years of life lost (SEYLL)i +
Σjdisability durationj*disability severityj (1)
The following steps to calculate the number of DALYs per
United States industry sector output are described in the
Supporting Information S1: (1) quantify number of fatality
and morbidity cases; (2) determine duration of the disabilities
per case; (3) evaluate severity of the disabilities per case; (4)
use the economic United States input-output model to
TABLE 1. Summary Statistics on 491 United States Sector Results Reported in Appendix S1
employees wages av fatalities YLD 1999 DALYs
establishments per per 1996-1999 per YLL 1996-1999 per per DALYs/
industry per million $ million $ million $ million $ per million $ % direct million $ % direct million $ % YLL employee
min 0.11 0.59 38250 0.000019 0.00069 #0.00 0.000049 #0.00 0.00074 0.17 0.00031
max 5.96 a a 0.024 0.89 #1.00 0.092 #1.00 0.96 0.98 0.079
max/min 54 <63b <26c 1280 1280 1876 1290 256
average 0.69 14.19 435397 0.0012 0.044 0.30 0.019 0.46 0.063 0.62 0.0050
median 0.50 12.26 411000 0.00069 0.026 0.21 0.018 0.46 0.045 0.61 0.0037
std/av 0.85 1.00 0.86 1.62 1.62 0.89 0.55 0.46 1.19 0.23 1.03
a Unreasonably high. b Excluding employee numbers for sectors with wages > output. c Assuming a maximum of $1 wages per dollar output,

# 0 refers to sectors where no direct injuries were considered, 1 refers to “Royalties” where no supply chain was considered, YLL ) Years of Life
Lost, YLD ) Years Lived Disabled, DALYs ) disability adjusted life years, STD ) standard deviation, $ ) 1997 United States dollars.

calculate upstream impacts in the supply chain of sectors;

and (5) match the disability data with the input-output
sectors.
Here we discuss the results of these calculations and show
its application in an illustrative example.
2.1 Direct and Cumulated Intensities per Industry Sector
Output. The transformations described in the Supporting
Information S1 provide the following information for each
industry sector: fatality cases for 1996, 1997, 1998, 1999, years
lived disabled (YLD) for 1999, number of employees (without
self-employed and contractors), number of establishments,
and wages paid. These vectors were then normalized by the
sector output per million dollars (1997) resulting in direct
intensities per industry sector. The detailed results are
provided in Appendix S1 and can be obtained from the
authors in electronic format.
Table 1 summarizes some characteristics of the intensities
reported for 491 sectors.
1. The spread of years of life lost (YLL), years lived disabled
(YLD) and consequently disability adjusted life years (DALYs)
between the sectors is larger than a factor of 1000. At the
same time, the spread in number of establishments, number
of employees, and total wages is clearly less than 100. This FIGURE 1. Disability adjusted life years (DALYs) due to occupational
confirms that none of these economic characteristics would health impact per United States sector output in 1997 United States
serve as proportional predictor for occupational injuries and dollars and per employee, respectively. The bars for “Other Federal
illnesses. Government enterprises” include only the supply chain but not the
2. For half of the United States sectors 21% or less of the enterprises themselves. nec ) “not elsewhere classified”.
fatality cases occur in the sector itself, while 79% or more
occur in the supply chain. For nonfatal injuries and illnesses The spread and coefficient of variation (ratio of standard
46% of the years lived disabled occur in the sector itself. The deviation to average) are smaller for DALYs per employees
same share for employees is 51% (not shown in Table 1). than DALYs per million dollars output. This is expected since
This suggests that YLD follow more closely the number of one would expect a correlation between number of employees
employees, while fatalities occur more often in the few and number of injuries and illnesses and because some of
primary sectors (sectors in agriculture, mining, fishing, and the high-risk jobs are in sectors with low-skill and low-wage
forestry). This is indirectly confirmed by dividing YLL and workers, while many low-risk jobs are in sectors with highly
YLD by the number of employees per sector. The ratio of paid, high-education jobs.
maximum to minimum intensities is 289 and 158; the ratios The maximum values reported for number of employees
of standard deviation by average are 1.42 and 0.45 for YLL/ and wages per million dollars sector output are unreasonably
employee and YLD/employee respectively (not shown in high because schools, colleges, and some other institutions
Table 1). While such a normalization by number of employees have a lot of employees and pay a lot of wages without
reduces the spread between highest and lowest intensities adequate output reporting. However, the reported averages
by factors of 4.4 and 12, respectively, the relative standard are representative for many sectors, and the ratio of standard
deviations are reduced only slightly which indicates that the deviation by average indicates the large spread between
correlation between injuries and number of employees is sectors.
higher for sectors with extremely high or low relative risks Figure 1 illustrates some of the variation found among
than for the more average sectors. the sectors picking 14 sectors from different types of
3. The standard deviation between the four time series industries. Without surprise, the DALYs per million dollars
for fatalities (1996-1999) varies between 0.9% and 165%. output are especially high for agriculture (here dairy farm
The average standard deviation is as low as 22% and the products), mining (here coal), and transport (here trucking).
median only 14%. This indicates that averaging several years As expected they are very low for insurances, legal activities,
is important for some, mostly smaller, sectors, and the and other “paper jobs” like advertising. Figure 1 also displays
uncertainty remains large for these sectors. However, it also results of DALYs per 10 employees. This shows relatively
says that for half of the sectors the standard deviation is 14% higher impacts for utilities, retail trade, and government and
or smaller and the year to year variation is small. decreases for dairy farm products and trucking. Except for

VOL. 37, NO. 10, 2003 / ENVIRONMENTAL SCIENCE & TECHNOLOGY 9 2027
TABLE 2. Occupational Health Impacts from the Life Cycles of One Million Steel and Plastic Fuel Tanks for Cars
input in cases of fatalities Years Lived needed wages in
million $ av (1996-1999) Disabled (1999) DALYs employees million $
Per Million Steel Tanks
manufacturing supply 39.87 0.039 0.73 2.2 424 16
manufacturing itselfa 50.67 0.0051 0.41 0.60 228 9.6
use phase supply 16.65 0.013 0.13 0.60 119 5,2
end of life supply -4.67 -0.0034 -0.079 -0.21 -46 -1.9
total 102.51 0.054 1.2 3.2 725 29
Per Million Plastic Tanks
manufacturing supply 19.26 0.012 0.26 0.72 178 7.2
manufacturing itselfa 66.71 0.0068 0.54 0.79 301 12
use phase supply 10.68 0.0081 0.081 0.38 77 3.4
end of life supply -0.36 0.00054 -0.00035 0.020 -2 -0.14
total 96.29 0.028 0.88 1.9 553 23
a Only injuries and illnesses within the “Motor vehicle parts and accessories (590302)” sector were included, $ ) 1997 United States dollars.

“Other Federal Government enterprises” this can easily be
explained by comparably low and high labor input per dollars
sector output, respectively. For “Other Federal Government
enterprises” the result is an artifact because the displayed
numbers include only indirect contributions but not the
governmental enterprises themselves.
Viscusi and Zeckhauser (20) estimate for 1987 the number
of workdays lost due to injuries per million dollars output
for a 38 sector model of the United States economy to be 0.1
(real estate) to 1.2 (furniture and fixtures). Estimates for the
number of fatalities per million dollars sector output are
based on a more aggregated 8 sector model and lead to results
ranging from 1.7 × 10-4 (finance, insurance, and real estate)
to 2.15 × 10-3 fatalities (agriculture, forestry, and fisheries).
These results suggest that more aggregated sector models
reduce the spread among sectors dramatically (from 3 to 1
order of magnitude). The fatality intensities are similar to
our results; the number of work days lost are lower which
may be due to the fact that they did not include a best estimate
for the cases with 31 or more days away from work. CMU
(24) used the input-output table of 1992 and BLS data for
fatality cases and workdays lost for the year 1992. The CMU
results for fatality cases are similar to our results, while those
for lost workday cases appear low.
2.2. Steel versus Plastic Fuel Tank Systems for Auto-
mobiles. How can these data on occupational health be
applied in product design and policy? A case study on fuel
tanks illustrates one potential application.
A switch from steel to plastic fuel tanks reduces vehicle
weight and fuel consumption. Joshi (33) investigated whether
this switch is preferable from an environmental point of view
combining process analysis and input-output techniques
in a hybrid life cycle assessment approach. Much data were
taken from an earlier life cycle assessment relying on process
analysis only (34). The comparison excluded parts that are
common to both alternatives such as fuel lines and filters
but included the tank itself, straps that secure the tank, and
a shield. The steel tank uses a plastic shield to protect it from
damage and corrosion. The multilayer high-density poly-
ethylene tank system uses a heat shield made from steel. The
analysis also included the attributable fuel use and its
resulting emissions and the shredding of the tank system at
the end of a 177 000 km lifetime.
Both life-cycle assessments concluded that the new plastic
tank system is environmentally preferable in most environ-
mental impacts (33, 34). Hazardous waste generation and
the emission of ozone depleting substances were the two
exceptions where the steel tank system scored better.
Let us assume that the plastic tanks are indeed environ-
mentally superior. Which tank system has lower attributable
health impacts from occupational injuries and illnesses? To
answer this question, we make use of the results presented
in Section 2.1 that report attributable disability and fatality
outcomes per million dollars of sector output. Joshi (33) lists
purchases from about 30 U.S. Bureau of Economic Analysis
(BEA) sectors to produce, use, and dispose of 1 000 000 fuel
tanks for cars made from either steel or plastic. However,
these inputs do not cover the manufacturing step itself, the
driving of the car (just the purchase of fuel due to the tank
weight), and the shredding itself. Joshi (35) states the
estimated total manufacturing costs per fuel tank, which
allows calculation of the costs of the manufacturing process
itself. This will be treated as output from the “Motor vehicle
parts and accessories (590302)” sector. Occupational injuries
in the maintenance, use, and disposal phases itself were
omitted. The dollar amounts in ref 33 are in 1987 dollars.
Chain-type price indexes for gross output by industry (36)
allow us to calculate the 1997 dollar values. These values are
then used together with the data in Appendix S1 to calculate
the numbers displayed in Table 2.
Before we interpret Table 2 we need to be aware of several
simplifications and assumptions that make the present
example academic. The data used was valid for the early
1990s and one type of tank system. Present fuel tank systems
for different cars may deviate considerably from the presented
data. Excluding occupational injuries of the shredding process
itself may not be justified. Many of the used sectors produce
a set of different products, and the specific product here
may not reflect an average product of the respective economic
sector. As suggested in Section 2.1 and further discussed in
Section 3, the data used to calculate the fatalities and
disabilities per sector are not only variable from year to year
but also highly uncertain with a bias toward underestimating
the true value. Finally, the calculated number of needed
employees and their wages are rough estimates only.
The results show that while the life cycle costs for the two
tank systems are very similar in our example the number of
fatality cases is almost twice as high for steel tanks. Producing
19 million steel tanks or 36 million plastic tanks statistically
causes one occupational fatality case somewhere in the
product system. Nonfatal injuries and illnesses are about
35% higher for steel tanks than plastic tanks which results
in about 70% higher disability adjusted life years (DALYs) for
steel tanks compared to plastic tanks. However, this comes
also at the expense of number of employees and wages paid
(see Section 4).
The preliminary conclusions of this case study are that
the plastic tank system studied does not only causes lower
environmental impacts but also causes lower attributable
occupational injuries than the steel tank system. However,
this second conclusion will be challenged in Sections 3.1
and 4.

2028 9 ENVIRONMENTAL SCIENCE & TECHNOLOGY / VOL. 37, NO. 10, 2003

TABLE 3. Comparison of United States Occupational Health
Cases Reported by BLS and Our Best Estimate
occupational cases reported by BLS
1999 and available by best % covered
in thousands industry sector estimate by BLS
fatal injuries 6.023 >6.023 <100%
fatal illnesses 0 56-86 0%
total fatality cases 6.023 62-92 6.5-10%
nonfatal injuries 5335 9257 58%
nonfatal illnesses 372 905-995 37-41%
total nonfatal cases 5707 10 162-10 252 56%
3. Critical Appraisal
Section 2 shows that the data provided by BLS allows us to
estimate disability adjusted life years due to occupational
injuries and illnesses on the most detailed sector level where
input-output models are available. Here we ask whether
our results in Appendix S1 cover the true magnitude of
occupational health impacts and whether they matter
compared with other impacts. To do so, we address the
following questions: (1) How do the numbers reported by
BLS compare to “true” number of injuries and illnesses? (2)
How large are the occupational health impacts compared
with environmental health impacts? (3) How do individuals
and society value one fatality case due to occupational injuries
or illnesses compared with environmental illnesses, nonwork
related injuries, or nonwork-related illnesses?
3.1. How Complete Are the Available Statistics? There
are four reasons why the available statistics tend to under-
estimate the true number of injuries and illnesses.
1. Not all United States businesses are required to report
injuries and illnesses. For instance, BLS’s Annual Survey of
occupational injuries and illnesses does not include self-
employed employees, governmental employees, private
household workers, and farms with fewer than 11 employees.
2. Employers have economic incentives to underreport
injuries in order to minimize workers’ compensation pre-
miums or to avoid inspections by the Occupational Safety
& Health Administration (OSHA).
3. Employees may hide injuries or illnesses to avoid being
laid off or to maximize their chance for promotion.
4. The injury or illness is not recognized as work-related,
e.g., traffic accidents during work-time are often not rec-
ognized as occupational injuries and delayed or chronic
illnesses are often not attributed to work environments.
Following the work of Leigh et al. (37) who suggested
estimates for these undercounts for 1992, we provide, in
Supporting Information S2 data, assumptions and calcula-
tions that lead to the following updated estimates for fatal
and nonfatal injuries and illnesses.
Best Estimates for Occupational Health Cases in 1999. Table
3 provides a summary of the number of occupational health
cases that have been reported by BLS and used in Section
2 and the new estimates based on Supporting Information
S2 and Leigh et al. (37). These numbers suggest huge
undercount for fatal illnesses and a considerable undercount
for nonfatal injuries and illnesses.
The resulting total of 56-86 000 illness-related deaths is
about 10-fold higher than the fatalities due to injuries reported
by BLS. Therefore, while the statistics on injury-related
fatalities may provide a good basis to minimize those fatalities,
it may well miss an overall reduction of work-related fatalities
by transformations into safer but less healthy workplaces.
When we compare the injury-related fatalities with these
illness-related fatalities we need also to keep in mind that
the injuries were related to production in 1999, while many
of the illness-related fatalities may be related to production
in the 1940s-1990s, i.e., the illness-related fatalities for
production in 1999 may well be different from the numbers
in Table 3.
Further, when we compare the years of life lost due to
injuries versus illnesses, we need to take into account that
an average fatal injury case causes 37.3 years of life lost while
an average illness case, due to the delayed nature of the
illnesses, causes probably 10-20 years of life lost (38).
Therefore, on the basis of years of life lost, the illness-related
burden of disease outnumbers the injury-related burden
between 3- and 8-fold. Considering that this undercount is
less for nonfatal injuries and illnesses and that 66% of the
total DALYs calculated according to BLS are fatality related,
the total undercount in DALYs can be estimated to be between
3- and 7-fold.
These new estimated numbers are not available on a per
sector level. Applying simple extrapolation factors for all
sectors would not account for the very different type of
occupational risks caused by different sectors. To achieve
this, one would have to gather information on actual worker
exposure in the different sectors and apply, where available,
the information on dose-response functions. This is a huge
task but might be feasible for single production facilities or
parts of sectors. Therefore, we can conclude that our
calculations for fatality cases in Section 2.2 and Appendix S1
are good lower-bound estimates for fatal injuries, and all
other numbers reflect neither the magnitude of impacts nor
necessarily true relative differences among sectors.
3.2. Environmental Illnesses from Industry Activities.
To see how these occupational health impacts compare to
environmental health impacts we will compute predicted
environmental health impacts in DALYs per million dollars
sector output. For this purpose, we need a model that links
emissions per sector with the economic IO table and a model
that links emission data to health impact measured in DALYs.
Presently, there are two extended input-output models
for the United States economy publicly and freely available
(24, 39). Here, MIET2.0 (39) was used because it uses the
more recent IO-table (1996), it uses more recent and therefore
more comprehensive environmental data (mostly 1996-
1998), and it also includes the model to link emissions to
DALYs, the impact assessment method “Eco-Indicator’99”
(32). However, these more recent sources are also incomplete
and rely sometimes on estimated rather than actually
occurring emissions. Further, MIET2.0 is built on a 91 sector
model instead of the 491 sectors used for occupational health.
This latter limitation implies an averaging effect and will
reduce the spread between different sectors for DALYs per
dollar output.
The impact assessment method “EcoIndicator’99” uses
European background data for local and regional effects. To
adjust for the lower population density in the United States,
the results for carcinogenic and respiratory effects were
divided by two. Further, we took into account that the unit-
risk approach used for carcinogenic effects is conservative
and about a factor of 2 higher than best estimates (40). Finally,
we present only values for the hierarchists’ perspective; the
egalitarians’ values are practically the same, and the indi-
vidualists’ values are 20%-65% lower for different sectors.
There are two main reasons for this difference: first, cause-
effect relationships with moderate and low evidence are not
considered in the individualistic world view and second, age-
weighting was applied which discounts illnesses and pre-
mature deaths at high age.
Figure 2 shows that within the arbitrarily chosen 14
industry sectors there is a spread of 100 between the lowest
and highest impact intensity. Although occupational and
environmental health impact intensities are consistently low
for insurance, legal, and advertising services; midrange for
plastics, metalworking machinery, and truck and bus bodies;
VOL. 37, NO. 10, 2003 / ENVIRONMENTAL SCIENCE & TECHNOLOGY 9 2029

FIGURE 2. Disability adjusted life years per million 1997 United
States dollars of output from few selected United States industry
sectors.
and high for coal mining, they are inconsistent for the other
sectors. Some of these differences can be explained. The
environmental health consequences of agricultural products
are very likely even larger underestimates than for oc-
cupational health because many nonpoint sources are not
considered and cause-effect relationships between emis-
sions and human health are not well established. The high
environmental scores of primary iron and nonferrous metal
manufacturing are expected, and their occupational health
impact would be higher if fatal but delayed illnesses would
be considered as well. While the environmental health
impacts of power plants are indeed high, the occupational
impacts may well be low per dollar output. Retail trade and
trucking are two sectors where occupational impacts are high
compared to other sectors, while environmental impacts are
low or moderate, respectively. This may be explained by the
fact that the value of the output is not the sector output but
instead is equal to the “margin” or mark-up on the cost of
goods sold. This margin then is used to pay for required
inputs to, say, retailing or trucking (gasoline, trucks, lights
in the store, etc.), with the remaining income being “value
added”.
When we compare environmental with occupational
health impacts and assume that the 14 sectors in Figure 1
correspond with those in Figure 2, then the environmental
health impacts are between 6 times (dairy farm products)
and more than 300 (electrical utilities) times higher than
occupational health impact (average is factor 50) per dollar
sector output. However, considering that the numbers in
Figure 1 would probably be 3-7-fold higher (Section 3.1) if
all occupational health impacts would be considered, the
difference between environmental and occupational health
would be closer to an average factor of 10 instead of 50.
This suggests that, on average, environmental health
impacts dominate occupational impact to an extent that
occupational impacts are smaller than the uncertainty of the
analysis. However, in single sectors, and therefore also in
specific applications, occupational health impacts may have
the same order of magnitude as environmental impacts.
3.3. How To Compare Health Impacts from Different
Sources? So far, we made the implicit assumption that fatality
cases due to occupational injuries, illnesses, or environmental
illnesses can be added once age at death is considered. Are
deaths due to work comparable to those due to environmental
or other nonwork causes? Is a death due to an injury worse
than one due to an illness? By using disability-adjusted life
years (DALYs) we implicitly assumed that age at death and
duration and severity of disabilities are sufficient to make
impacts from work-related injuries and illnesses comparable.
2030 9 ENVIRONMENTAL SCIENCE & TECHNOLOGY / VOL. 37, NO. 10, 2003
Therefore, we can simply ask if a DALY is independent of its
cause? And if not, what are the exchange rates for DALYs of
different causes?
There are two different bodies of research that are likely
to provide insights into these questions: research that looks
into revealed preferences and experimental studies that use
expressed preferences. Our review of this literature in
Supporting Information S3 finds that both approaches
suggest that the same magnitude of (fatality) risk is valued
differently depending on its nature and cause. However, our
review also shows that the exchange rates found in the
literature are for more specific types of risks and that it is not
possible to easily generalize them for broad categories such
as occupational or environmental health. Here we leave this
issue as a research need by noting that (1) simple addition
of fatality cases within and among occupational and envi-
ronmental health may not be justified, and (2) evidence
provided in Table S3 suggests that health impacts due to
environmental causes are considered at least as important
as occupational causes and that it is likely that an environ-
mental DALY may be valued as more important than an
occupational DALY.
This last finding means that it is conservative to compare
occupational and environmental health impact with an
exchange rate of 1 per DALYs if we want to show the
comparably lower importance of occupational health im-
pacts.
4. Consequential Occupational Health Impacts
Sections 2-3.2 elaborate on the question of which oc-
cupational and environmental health impacts can be at-
tributed to the provision of services and products or, as done
here, are associated with sector outputs. However, to inform
product design and policy we are more interested in the
following question: which course of action results in the
fewest health impacts.
The explicit distinction between attributional and con-
sequential analysis in the field of life cycle assessment (LCA)s
a tool that is supposed to inform product design and policys
has been introduced more recently (e.g., refs 41-44).
In this paper we focus on occupational health. Therefore,
we may refine the above question and ask the following:
How do changes in product design and policy affect
occupational health and what other changes in health are
induced.
To shed light on these questions we need first to list
potential changes that may be caused by product decisions
that affect occupational health.
A Terminology for the Effects. First, there are so-called
direct and indirect rebound effects (45-46): (1) Direct
Rebound Effect (substitution effect, pure price effect): Greater
efficiency may lead to a lower price of the service (or product
or technology) which in turn may induce an increased use
of this cheaper service. (2) Indirect Rebound Effect (income
effect, secondary effect): If prices of other commodities and
income are constant, the reduction of costs for one com-
modity due to a particular efficiency increase implies that
consumers have more money to spend on other goods.
The same rebound effects may also occur with respect to
time use, i.e., if time rather than money is the limiting factor
for a consumer, a time-saving service/device would allow
consumption of more of the same or another service. Both
direct and indirect rebound effects affect the magnitude and
distribution of industrial output, and potentially, therefore,
occupational health, e.g., if the fuel tanks in our example in
Section 2.2 would greatly differ in costs, one may need to
consider that this may boost car sales, enable additional
gadgets or horsepower in the car, or enable the purchase of
other goods. This calls for a careful analysis of changes in the
consumption pattern due to product decisions. This will not
be further elaborated here.
Further, Greening et al. (45) and Binswanger (46) define
the two following effects: (1) General Equilibrium Effect
(economy-wide effects): The direct and indirect rebound
effect leads to changed prices and consumption throughout
the economy, which may increase or decrease production in
distant sectors and changes the production functions. (2)
Transformational Effect: This includes changes in consumer
preferences, alteration of social institutions, and the rear-
rangement of the organization of production.
Computable general equilibrium models are usually used
by economists to model general equilibrium effects (47, 48);
transformational effects are often discussed more qualita-
tively and play an important role in technology assessment
(49, 50).
Market Reactions Due to Changes in Demand. Some
equilibrium and transformational effects are directly related
to occupational health. Our fuel tank example (Section 2.2)
demonstrates that the production of 1 000 000 plastic tanks
needs an estimated 172 fewer employees compared to the
steel tank. These people are not going to disappear and we
have therefore to ask, what are they going to do and how
does this affect their health risks. Possible market reactions
are as follows: (a) There is no job substitution. The workers
stay in the same sector and produce either the same goods
with lower productivity or with the same or higher produc-
tivity if market demand happens to increase in the same
period of time. They may also produce different and new
goods that need the same sector skills and infrastructure.
Occupational health risks remain similar or the same. (b)
There is a direct substitution with leisure time and/or
unemployment. Either the yearly working hours are reduced
or the 172 workers become unemployed. (c) There is
substitution within the economy. The workers will find new
jobs in other sectors. These jobs can have higher, the same,
or lower occupational health risks. If the economy is not
growing, this substitution will cause reduced yearly working
hours per employee or force workers into unemployment.
Since the 172 skilled workers may find new jobs, they may
indirectly force lower-skilled or more-expensive workers into
unemployment.
In reality, all three reactions may occur in parallel, but for
the discussion here we will consider them separately. If
reaction (a) dominates there would be no need to consider
occupational health impacts in product decisions. Instead,
one would focus on intrasector measures to reduce injuries
and illnesses. Large companies have proven that occupational
health impacts can be greatly reduced if it is a management
priority (e.g., refs 51-54), and the large within-sector-spread
of injury rates among companies confirms the potential for
improvements.
Structural changes in the economy are ongoing processes.
Old economy jobs get lost, new economy jobs, mostly in the
service sector, are added. Market reaction (c) is therefore
likely to show a general shift from old economy jobs into the
service sectors that often have lower occupational health
impacts. This shift may not be direct, i.e., a steel worker
losing the job due to new plastic tanks may find a job in
another higher risk job due to the worker’s skill but may
avoid that new work-force learn these old rather than new
economy skills. Such labor market models are often part of
general equilibrium models and can help to predict the most
likely market reactions due to changes in the consumer
demand. Once the shift in workforce is evaluated the
occupational health impact intensities may be recalculated
and replace the numbers in Appendix S1.
A CGE model with an integrated labor market model would
also be able to predict the needed working hours and with
some additional assumptions on union and policy interven-
tions predict changes in weekly work-time and unemploy-
ment rates. What health impacts are expected due to changes
in weekly work-time and unemployment rate?
Is Working or Not Working Safer? To get insights into this
question we first provide some numbers on the average
accidental and nonaccidental incidents per hour of work or
nonwork. Then, we look for answers on the true consequences
of reduced work hours.
The data in Table 4 suggest that the fatality risk per work
hour is about 10-fold lower than the fatality risk per awake
nonwork hour for age 15 and older. For the age-group 15-64
the same difference is only about 2-fold. For nonfatal
disabilities the data suggests that injury risks may be similar
for work hours versus awake nonwork hours but that the
number of illnesses may be more than 10-fold higher for
nonwork hours even when the age range is limited to 15-64
years. Several caveats apply. First, the estimates of work-
related fatalities due to illnesses are highly uncertain; second,
the data on nonfatal events are uncertain for both work and
nonwork related activities; third, work-related fatalities and
especially those due to injuries occur on average at lower
ages; and fourth, it is possible that work-related injuries and
illnesses are more severe than those that are nonwork-related.
While these data suggest that the working time is healthier
than the awake nonworking time they are not sufficient
evidence to answer whether working more or less hours would
change health in a positive or negative way. There are two
principal ways the labor market can react to an in/decreased
demand in work-hours: change in working-hours per week
or change in unemployment rate. The actual reaction of the
labor market depends on the timing of the change in demand
(short-term fluctuation versus long-term trend), the position
of unions in the concerned sectors, whether it is a general
boom/recession or rather a structural shift within the
economy, and on the availability of skilled workers. These
distinctions are relevant because they will influence the
actually substituted activities, i.e., whether fewer working
hours mean a less stressful life, more exercise and healthier
diet, or higher degrees of suicidal ideation, substance abuse,
and criminal behaviors.
Focusing on young adults Fergusson et al. (60) show that
after controlling for confounding factors and reverse causa-
tion (i.e., less healthy people are less likely to be employed)
exposure to unemployment was significantly associated with
suicidal ideation, substance abuse, and criminal behaviors.
This would suggest that if reduced demand of labor results
in higher unemployment rates for young people, then indeed
the nonworking hours are less healthy than the working hours.
Analyzing state data for the United States, Ruhm (61) finds
that a 1% rise in the unemployment rate is associated with
a 0.5-0.6% decrease in total mortality or a reduction of about
11 000 fatalities annually. These 11 000 fatalities translate
roughly into 4.4 fatalities that will be avoided by transferring
1 000 000 working hours into nonworking hours. This is not
only a different sign compared to what Table 4 suggests but
also about twice the awake nonworking rate and the 20-fold
of the work rate. If both the data in Table 4 and in ref 61 hold,
then this could mean that this 1% change in unemployment
would affect mostly sectors with the highest fatality rates
(e.g., agricultural and primary production sectors, see Ap-
pendix S1) and that within sectors the fatality rate would not
be proportionally distributed among employees but that the
highest risks would be carried by those most likely to become
unemployed. In the case of a short-term boom one can also
argue that a temporary increase in production may result in
greater use of labor and their health by (over)using existing
technologies, while longer term booms in some sectors will
allow for technological change and improvement and skilled
employees. Ruhm (61) also finds for an increase in unem-
ployment rate that the elasticity for motor vehicle accidents
VOL. 37, NO. 10, 2003 / ENVIRONMENTAL SCIENCE & TECHNOLOGY 9 2031
TABLE 4. Comparison of Average Fatal and Nonfatal Cases of Injuries and Illnesses Per Work- and Nonwork Hour for 1999,
United States Data.
cases per
case numbers comments hours [109]a million hours
Occupational
fatal injuries >6023 see Table 3 248 0.024
fatal others 55 663-86 402 248 0.224-0.348
fatal total 61 686-92 425 248 0.248-0.372
nonfatal injuries 9 257 000 248 37
nonfatal others 904 517-994 887 248 4
nonfatal total 10 161 517-10 251 887 248 41
Nonoccupational
fatal injuries 137 619 Hoyert et al. (55) for ages 15 and 963 0.143
unintentional 89 926 over minus occupational 963 0.093
thereof transport 41 447 963 0.043
intentional (suicide, homicide) 45 102 963 0.047
fatal others 2 120 574-2 151 313 963 2.202-2.234
fatal total 2 258 193-2 288 932 963 2.345-2.377
fatal injuries age 15-64 99 032 Hoyert et al. (55) for ages 15-64 808 0.123
fatal others age 15-64 361 843-392 582 minus occupational 808 0.448-0.486
fatal total age 15-64 460 875-491 614 808 0.570-0.608
nonfatal injury visits 15-64 >19 389 000 (56)b 808 >24
nonfatal others visits 15-64 521 350 000 ((57): Table 83)c 808 645
nonfatal total visits 15-64 >540 739 000 808 >669
a Rones et al. (58) calculate yearly work-hours for 1993 as being 1905 h/yr for employed men and 1526 h/yr for employed women. We esti-

mate for 1999 including agricultural and self-employed workers (that work more hours) 2000 h/yr for men and 1700 h/yr for women. From U.S.
Census ((59): 424) we extrapolate the total number of workers for 1999 to be 133.368 million with a share of 46.2% women.
(0.462*133.368*1700+0.538*133.368*2000 ) 104 747+143 504 ) 248 billion). From U.S. Census ((59): 411) we estimate the number of Civilian
noninstitutional population aged 16 and over for 1999 to be 207.328 million. This population spends about 16 h a day with other activities than
sleep (1211 billion hours). For the rows for 15-64 olds we excluded people 65 and over. b These injuries refer to hospital emergency department
visits only. Visits to physician offices and hospital outpatient departments are likely to be as high as those reported. It is not possible to derive
the number of cases from the number of visits. c These visits split as follows: physician office: 428.916, hospital outpatient departments: 50.405,
hospital emergency departments: 42.029. It is not possible to derive the number of cases from the number of visits.

is five times higher (major explanations include less driving
and drinking in recessions) and that deaths from cardio-
vascular disease, liver ailments, and flu/pneumonia decrease
substantial. He explains the latter by reduction in obesity
and smoking and an increase in healthy diet and exercising
during times of recessions. However, he also finds that suicide
rates go up in recessions and that sustained economic growth
(rather than fluctuation booms and recessions) may improve
public health.
The latter is addressed by the growing literature on wealth-
health analysis (e.g., refs 62-65), and it seems inconclusive
whether relative income distribution alone or absolute wealth
and its distribution explain all observed variation (65). Ruhm
(66) shows similar results for nonfatal health measures where
physical health worsens when the economy temporarily
improves, but he also finds that mental health improves.
While Ruhm acknowledges that unemployed individuals are
in poorer average health than those who work (e.g., refs 67),
he shows that this is a cause for joblessness (e.g., ref 68)
rather than a consequence of joblessness and is also a major
reason many previous studies suggested that an increase in
unemployment rates would decrease public health. Such an
example is Cohen (69) who finds that unemployment
decreases the life expectancy by 1.4 years due to an increase
in death risk of 4%. Finally, Novo et al. (70) concentrate on
the health of the young employed population in times where
the unemployment rate changes due to booms and reces-
sions. They find more ill-health among women during
recessions and suggest that pessimism about the future, high
demands, financial problems, and lack of control over work
may be important contributing factors to ill-health during
recessions.
This very short dive into only the most recent literature
suggests that there is mixed evidence on direction and
magnitude of the effects on health in times of recessions or
booms. Since product policies will at best contribute to a
structural shift in the economy, much more detailed studies
would be needed to predict the effects on public health due
to such changes in the labor market.
5. Discussion
Why and how should we assess occupational health impacts
in integrated product policy? Integrated product policy and
life cycle assessment traditionally have a strong focus on
environmental effects. This focus would not detect shifts
from environmental health effects to occupational health
effects and therefore could lead to suboptimized product
systems from a broader health perspective. Including oc-
cupational health impacts in parallel with environmental
impacts would allow better guidance for minimizing overall
impacts. However, since occupational health impacts are
partly internalized, they should not be used when only
external effects are being quantified. Further, the assessment
of occupational health effects needs to be facilitated to reduce
the burden of analysis and needed level of expertise.
This leads us from the “why” to the “how”, the main focus
of this paper. Here, we provide and quantify a model for
attributional occupational health effects on an industry sector
level, discuss paths to assess consequential occupational
health effects, and compare the results with environmental
health effects.
Our model for attributional occupational health effects
uses the information on occupational injuries and illness
collected by the U.S. Bureau of Labor Statistics (BLS) for
1999 and aggregated these data into the same 491 industry
sectors that are used by the U.S. Bureau of Economic Analysis
(BEA) for the economic input-output table for 1997. The
health impacts are first separated into fatality cases and a
severity adjusted indicator for morbidity cases and then
aggregated into disability adjusted life years (DALYs). Making
use of the economic relationships among the sectors and
assuming that occupational health impacts can be allocated
on a per dollar basis allows us to consider all supply chain

2032 9 ENVIRONMENTAL SCIENCE & TECHNOLOGY / VOL. 37, NO. 10, 2003
impacts. Appendix S1 provides the detailed results for 491
sectors.
The statistics from BLS neither cover all United States
workers nor capture all injuries and illnesses that are caused
by occupational environments. Therefore, we follow a
procedure suggested in Leigh et al. (37) to estimate the true
occupational health impacts for 1999 using a more top-down
approach, other health statistics, and epidemiological find-
ings.
Instead of creating a model for consequential occupational
health impacts, we provide a framework for the type of
consequences such a model would need to take into account.
Health effects of short- and long-term changes in employ-
ment rates, with employment being one of the major potential
occupational consequences of integrated product policy, may
deserve the highest priority in future research.
Finally, we also used the United States economic input-
output model to calculate environmental health effects (39)
per industry sector output in order to compare those effects
with occupational health impacts. Whether health effects
with the same duration and severity can be valued equally
when they occur in an occupational, environmental, or
nonwork setting was analyzed by relying on revealed and
expressed preference studies.
The approaches taken each have their own limitations.
Psychosocial impacts of working environments are not
included in our analysis, and the data used apply to the United
States only. The supply chain model used does not consider
infrastructure and governmental inputs and makes the
assumption that occupational health impacts of a sector can
be equally attributed to each dollar output of the respective
sector. Further, we made the assumption that injuries and
illnesses that are reported or estimated for 1999 occurred
due to production in 1999 and that these data may be used
for future decision support. The analysis was also limited by
adapting a European impact assessment method to quantify
environmental health impacts in the United States without
indicating the range of uncertainty behind these calculations.
Despite these limitations this analysis allows us to suggest
some answers to the questions initially posed.
How Can Information That Is Available on Occupational
Health Be Used for LCA/Product Policy? The results in
Appendix S1 of our attributional occupational health model
provide up-to-date information on occupational health
impacts per industry sector. If sector data are sufficient these
data can directly be used in case studies (see Section 2.2).
The data are presented in disability-adjusted life years per
dollar sector output and can therefore easily be interpreted
by nonexperts. Therefore, the two practical concerns against
using occupational health impacts in integrated product
design and life cycle assessment seem resolved. If sector data
are not sufficient, e.g., because needed products deviate in
their nature and production risks from the sector average or
will be manufactured in the future only, process specific data
needs to be collected that is largely unavailable.
Do the Occupational Health Rates Vary Enough Among
Sectors To Justify This as a Discriminating Input into Decision
Making? The results provided in Appendix S1 and sum-
marized in Table 1 suggest that severity- and duration-
weighted occupational health impacts vary by more than a
factor of 1000 per dollar sector output between the lowest
and highest impact sectors. For instance, fishermen, lum-
berjacks, or builder’s laborers face considerably higher fatality
risks than lawyers, computer specialists or bankers because
they are exposed to dangerous machinery, altering weather
conditions, and falling trees or building materials. The
interannual variation and the assumptions on duration and
severity lead to an uncertainty that is much lower than a
factor of 1000. Therefore, United States occupational health
data do discriminate among outputs of different sectors.
How Complete Is the Available Information? The statistical
United States data provided by BLS are fairly complete for
fatal workplace injuries. However, our data suggest that
workplace-related illnesses that lead to fatality cases out-
number the injury-related cases by far but are missing from
available statistics. Large undercounts are also found for
nonfatal impacts. We estimate that the presented results in
Appendix S1 undercountson averagesthe true number of
disability-adjusted life years by a factor of 3-7. On a per-
sector level the undercount may be much larger or smaller.
Therefore, the results from our attributional occupational
health model provide reasonable lower-bound estimates for
fatal injuries but neither reflect the true magnitude of
occupational health impacts nor necessarily reflect the
relative differences between sectors.
Do Occupational Injuries and Illnesses Matter When
Compared to Health Impacts Due to Environmental Impacts
of Companies? Our analysis of context dependent preferences
for health suggests that the same type of disabling effect
(controlling for duration and severity) due to environmental
impacts is at least as severe as the same occupational impact.
The median exchange rate between environmental illnesses
and work-related illnesses was 1.6. For environmental versus
work-related injuries the median exchange rate was 2.3.
However, the full range was between 1 and 60. Assuming an
exchange rate of 1 and comparing the number of DALYs due
to environmental health impacts with those for occupational
health impacts suggests thatson averagesthe occupational
health impact numbers provided in Appendix S1 are a factor
of 50 lower than those for environmental impacts. If the large
undercount in the Appendix could be considered this may
reduce the difference to a factor of 10. However, on a per
sector level there may be sectors where occupational impacts
dominate environmental health impacts. Those would be
sectors with low emissions to the external environment and
large numbers of delayed health impacts due to hazardous
work environments.
How Likely Is It That an Increase in Demand in a Certain
Sector Actually Leads to a Proportional Increase in Oc-
cupational Injuries and Illnesses? We do not provide enough
evidence in our paper to answer this question in a quantitative
way. We identified the need to use labor market models to
get insights into the substitution mechanisms concerning
labor. Further, time-series data that allow controlling for
confounding effects may help to illuminate how occupational
health impacts of growing and shrinking sectors change. Our
untested hypothesis would be that the occupational health
impacts per sector output increase for both growing and
shrinking sectors, because shrinking markets may function
with old and insufficiently maintained infrastructure (and
low output) while growing sectorssat least in a short terms
may overuse existing production capital which may lead to
higher worker impacts.
If a Design, Purchase, or Policy Decision Changes the
Working Hours/Employment Rate, How Should We Consider
This in Our Analysis? Is It Relevant What We Assume? In
addition to our response above we discuss results in the
literature that suggest that changes in the unemployment
rate impact health in a relevant manner but with mixed
findings regarding the sign of these impacts. This literature
also suggests the importance of distinguishing short-term
fluctuations versus long-term changes, the latter being more
relevant for product policies.
This leaves us with the cardinal question: should we
consider occupational health impacts in integrated product
policy and how. The pragmatic answer is that attributional
analyses using only the occupational health impact data that
are collected by companies and available from statistical
bureaus will significantly undercount the true impacts, does
not reflect true consequences of product decisions, and will
VOL. 37, NO. 10, 2003 / ENVIRONMENTAL SCIENCE & TECHNOLOGY 9 2033
be expected to yield attributional results that are usually
minor compared to environmental health impacts. Being
unable to come up with good estimates for the “true”
occupational health consequences of product decisions
suggests that for today’s product decision making we are
compelled to neglect these impacts.
Based on our analysis we also suggest that in order to be
able to consider occupational health within IPP in the future,
methods need to be able to predict long-term health effects
from present-day workplace exposure and to account for
likely changes in the labor market, including changes in
unemployment rates and other substitution mechanisms.
Similar developments will be neededsand are ongoingsin
environmental life cycle assessment, and a combination of
efforts may prove fruitful.
Acknowledgments
We would like to thank Jim K. Hammitt (Harvard School of
Public Health, Boston), Sangwon Suh (CML, Leiden, NL),
and three anonymous reviewers for their helpful comments
and the BLS for providing unpublished research files for the
fatality data. Patrick Hofstetter was supported, in part, by an
appointment to the Postdoctoral Research Program at the
National Risk Management Research Laboratory adminis-
tered by the Oak Ridge Institute for Science and Education
(ORISE) through an interagency agreement between the U.S.
Department of Energy and the U.S. Environmental Protection
Agency. This article may or may not reflect the views of the
supporting agencies.
Supporting Information Available
Calculating disability adjusted life years per industry sector
output (S1), estimating total number of occupational health
impact (S2), review of the literature on context dependence
of value of life (S3), and cumulated results of a 6-tier model
for the United States economy for 1997 (Appendix S1). This
material is available free of charge via the Internet at http://
pubs.acs.org.
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